Nine local hospitals are being rewarded and six are being penalized as part of a new Medicare program mandated by national health care reform that seeks to improve the quality of care while reducing cost.

The money being reimbursed to the hospitals for Medicare patients is being based for the first time on a formula that includes quality criteria, such as whether antibiotics are administered within an hour after surgery, and patient satisfaction surveys.

The new formula is in addition to penalties implemented by Medicare last year that reduce reimbursements for hospitals whose patients are readmitted within 30 days of discharge.

In 2014, the program will expand to include new ways of measuring hospital performance.

Sharp Healthcare, which operates four hospitals in San Diego County, was both rewarded and punished by the new quality of care measures. Sharp Coronado Hospital earned the biggest bonus in the county, increasing its Medicare reimbursement rates by 0.58 percent. Sharp Grossmont Hospital in La Mesa was docked the most, seeing its rate reduced by 0.50 percent.

The Centers for Medicare & Medicaid Services published its list of bonuses and penalties for 3,000 hospitals nationwide on Dec. 20. The program affects 1 percent of Medicare’s hospital reimbursements, estimated to be $964 million for the 2013 budget year.

Medicare uses a complex set of quality measures and patient survey results, collected from July 1, 2011, through March 31, 2012, to decide which hospitals gain and lose money.

The quality criteria, which make up 70 percent of a hospital’s score, measure how well hospitals follow industry best practices that affect the timeliness and effectiveness of care. They include such things as the percentage of heart attack patients given medication to avert blood clots within 30 minutes of arrival.

The other 30 percent is taken from patient surveys after discharge. They include questions on such things as how well nurses communicated with patients and how responsive hospital staff were to patients’ needs.

Daniel Gross, executive vice president of hospital operations at Sharp, said the biggest difference between Coronado and Grossmont was the score for patient satisfaction. Grossmont earned a 36, and Coronado had a 92 out of a possible 100.

Both hospitals, Gross said, have tried to please their patients. Sharp offers various niceties, from aromatherapy in rooms to volunteers baking fresh cookies in its lobbies.

However, Gross said, there are other factors that can be much more important in satisfying patients. Grossmont, with more than 500 licensed beds, is much larger and busier than Coronado, which sleeps fewer than 60, he noted. Grossmont has the county’s busiest emergency department, with 100,000 visits per year.

Long emergency wait times can translate to negative opinions, especially at a hospital like Grossmont that admits many ER patients for overnight stays, he said.

“We know that 70 percent of patients admitted to Grossmont come through the emergency department. The ED experience starts to bleed into the overall patient experience,” Gross said.